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<title>Salud Online - Registro de Usuarios</title>
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		<h1><a href="#"><span>Salud@</span>Online</a></h1>
		<p>Creado por @Team UNFV-FIEI'05</p>
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		<ul id="main">
			<li><a href="index.php">Inicio</a></li>
			<li><a href="#">Diagnostico</a></li>
			<li class="current_page_item"><a href="#">Servicios</a></li>
			<li><a href="#">Acerca de Nosotros</a></li>
			<li><a href="#">Contactanos</a></li>
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			<h1>Registro de Pacientes</h1>
			
			<h3>Informacion Basica</h3>
			<form action="" method="post">
				<br/>
				<br/>
				
				<table>
					<tr>
						<td><label for="firstN">Nombres:</label></td>
						<td><input type="text" name="firstName" id="firstN" /></td>
					</tr>
					<tr>
						<td><label for="lastN1">Apellido Paterno:</label></td>
						<td><input type="text" name="lastName1" id="lastN1" /></td>
					</tr>
					<tr>
						<td><label for="lastN2">Apellido Materno:</label></td>
						<td><input type="text" name="lastName2" id="lastN2" /></td>
					</tr>
					<tr>
						<td><label for="birth">Fecha de Nacimiento:</label></td>
						<td><input type="text" name="birthday" id="birth" /></td>
					</tr>
					<tr>
						<td><label for="dni">DNI:</label></td>
						<td><input type="text" name="DNI" id="dni" maxlength="8" /></td>
					</tr>
					<tr>
						<td><label for="parentesco">Parentesco:</label></td>
						<td>
							<select id="parentesco">
								<option value="Padre">Padre</option>
								<option value="Madre">Madre</option>
								<option value="Hijo">Hijo</option>
								<option value="Hija">Hija</option>
								<option value="Nieto">Nieto</option>
								<option value="Nieta">Nieta</option>
								<option value="Abuelo">Abuelo</option>
								<option value="Abuela">Abuela</option>						
							</select>
						</td>
					</tr>
					<tr>
						<td><label for="bloodT">Tipo de Sangre:</label></td>
						<td>
							<select id="bloodT">
								<option value="null">-------------</option>
								<option value="A+">A+</option>
								<option value="A-">A-</option>
								<option value="B+">B+</option>
								<option value="B-">B-</option>
								<option value="AB+">AB+</option>
								<option value="AB-">AB-</option>
								<option value="O+">O+</option>
								<option value="O-">O-</option>						
							</select>
						</td>
					</tr>
					<tr>
						<td><label for="civilSt">Estado Civil:</label></td>
						<td>
							<select id="civilSt">
								<option value="null">-------------</option>
								<option value="single">Soltero</option>
								<option value="married">Casado</option>
								<option value="widowed">Viudo</option>
								<option value="divorced">Divorciado</option>						
							</select>
						</td>
					</tr>
					<tr>
						<td><label for="sex">Sexo:</label></td>
						<td>
							<select id="sex">
								<option value="null">-------------</option>
								<option value="male">Masculino</option>
								<option value="female">Femenino</option>								
							</select>
						</td>
					</tr>
					<tr>
						<input type="submit" name="submit" value="Enviar" />
					</tr>
				</table>
			</form>
			
		</div>
		<!-- end content -->
		
		<!-- start sidebars -->
		<div id="sidebar2" class="sidebar">
			<ul>
				<li>
					<form id="loginform" method="POST" action="#">
						<div>
							<h2>Inicia Sesion</h2>
							<ul id="error_list">
								<li>HEy</li>
							</ul>
                            <table>
                            	<tr>
                                	<td><label for="username">Usuario : </label></td>
                                </tr>
                                <tr>
                                	<td><input type="text" id="username"/></td>
                                </tr>
                                <tr>
                                	<td><label for="password">Contrasena: </label></td>
                                </tr>
                                <tr>
                                	<td><input type="text" id="password" /></td>
                       			</tr>
                                <tr>
                                	<td><input type="submit" name="submit" value="Iniciar Sesion" /></td>
                                </tr>
                            </table>
                            
                            <ul>
                            	<li><a href="registro.php">Crear una Cuenta</a></li>
                            	<li><a href="">Olvidates tu contrasena?</a></li>
                            </ul>
						</div>
					</form>
				</li>
				<li>
					<h2>Tags</h2>
					<p class="tag"><a href="#">dolor</a> <a href="#">ipsum</a> <a href="#">lorem</a> <a href="#">sit amet</a> <a href="#">dolor</a> <a href="#">ipsum</a> <a href="#">lorem</a> <a href="#">sit amet</a></p></li>
				
				
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	<p class="link"><a href="#">Politica de Privacidad</a>&nbsp;&#8226;&nbsp;<a href="#">Terminos de Uso</a></p>
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